In this Q&A session, Dr Helen Keen answers questions on Gout, a common and painful condition that affects the joints. The session covers questions such as the prevelance of gout; signs and symptoms; when to see a Rheumatologist; and how is gout medically managed.
Gout is a form of arthritis that occurs when uric acid levels in the blood rise above that which can remain soluble, and the uric acid crystallises. These crystals are deposited in soft tissues and joints, causing gout.
Gout is the most common form of arthritis in men but is rare in pre-menopausal women. The incidence of gout is increasing, particularly as the population ages. It is a disease associated with significant disability and illness and can affect more than just the joints.
Gout is best diagnosed by having a doctor take fluid from a joint and demonstrating the crystals in the fluid. Sometimes this is not possible, and a rheumatologist or other doctor may be reasonably comfortable in making the diagnosis of gout based on the symptoms. Sometimes the level of uric acid in the blood, and x-rays or a CT scan may assist in the diagnosis.
Gout usually affects people by causing arthritis, which is inflammation of the joints. Inflammation is associated with pain, swelling, heat and redness. The arthritis in gout usually affects peripheral small joints, and indeed the most typical presentation is an acutely inflamed big toe (sometimes termed podagra). But any joint can be involved, and it is common for gout to involve other joints of the feet, the ankles, knees, hands and wrists. Occasionally gout can affect joints of the spine, and sometimes gout can affect several joints at one time.
Acute gout usually comes on very suddenly, often overnight, with some people reporting tingling being the first symptom, followed by increasing pain which reaches a peak within about 12 hours. The acute attacks of gout usually settle over some days to weeks but can settle more quickly with treatment.
Acute attacks may be precipitated by many factors in people prone to gout. These include an excess of protein or alcohol in the diet, dehydration, infection, trauma and changes in medications, such as blood pressure medications.
If the high uric acid levels in the blood are not treated, then gout may progress, with ongoing pain, and the deposition of the crystals in soft tissue, including the skin. These deposits are called tophi, and often appear to be chalky lumps, often on the fingers or ears. Tophi can disappear with long term treatment.
Untreated gout can result in irreversible damage to the joint, and untreated high levels of uric acid are associated with cardiovascular and kidney disease.
There are good therapies for gout; however international guidelines state that the management of gout should not rely solely on medications. It is important for people with gout to be educated so they can understand their disease, and what factors may precipitate an acute flare. People with gout should undertake regular physical activity, and try to maintain a healthy body weight in order to reduce the risks. Dietary changes, decreasing the intake of meat, shellfish, fruit juices and other sugary drinks, alcohol (especially beer) as well as increasing the intake of water and dairy products may assist in preventing attacks of gout.
Additionally, people with gout should be screened for cardiovascular risk factors, such as high blood pressure, high cholesterol, and counselled about the risks of smoking.
The levels of uric acid in the blood can be lowered to prevent the development of acute attacks with drugs. The commonly used urate-lowering drugs include allopurinol, febuxostat and probenecid.
If an acute attack occurs, then the inflammation can be treated in the short term to resolve the attack with drugs such as non-steroidal anti-inflammatories, colchicine, and sometimes steroids.
These are often co-prescribed when you begin urate lowering drugs to manage any inflammation that may occur.
New drug therapies for gout have been developed, but these drugs are expensive, and can cause side effects, so they are usually reserved for people whose gout cannot be controlled in the usual way. These drugs include synthetic uricase enzymes that prevent the production of uric acid.
Maintaining healthy body weight, regular exercise, a healthy diet low in protein and sugar, and increasing fluid and dietary dairy intake may aid the self-management of gout.
Additionally, understanding your disease combined with taking your long term medication correctly, may mean you can better control your disease. Your Rheumatologist will be able to assist you with education regarding lifestyle and medications and assist you in developing a self-management plan to reduce the impact of gout in your life.
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Article written by Dr Helen Keen, AdjunctProfessor (Rheumatology) MBBS FRACP PhD
Dr Keen consultants at Royal Perth and Fiona Stanley Hospitals, privately in Subiaco, and undertakes teaching and research at UWA.
I work in the electorate office of a senior member of the WA Government. Being a desk job it is quite sedentary and weight has often been a problem over the years. I was very fit as a young man but for various reasons have not been sufficiently so for many years. Before this I was (respectively) a press photographer and journalist (20 years), private secretary, computer systems engineer, newspaper managing editor, sub-editor, and speech writer.
When I first suffered from gout I thought I’d twisted an ankle or foot. Soon, however, the pain was too great and the swelling lasted too long for that to be the case. I visited my Doctor and to my shock I was diagnosed with gout. I believed, like many do, that it was a disease of massive overindulgence and risky high living.
On the occasions I have had bouts, it has had a severe effect. When one can hardly move a foot, one isn’t much good at walking to work or, in fact doing anything. In fact, without treatment, the pain is so all-consuming that the sufferer cannot think of anything else but the pain and possible ways to relieve it.
I try not to consume some of the things I think contribute to gout and I try to drink lots of water and other liquids during the day. These days I am more sensitive to the onset of a possible bout and there is usually a prolonged period of days of feeling unwell for no particular reason, and one comes to recognise this is subtly different from other illness or weariness.
In my spare time I design paperback books and dust jackets, and edit and assess manuscripts for emerging writers. I used to play a lot of sport, particularly swimming, squash and cricket. However, an improperly-diagnosed Achilles injury failed to repair properly, largely curtailing the sporting activity. I write fiction (having completed 2 novels) and help other writers where I can. I’m also a committee member of the Fremantle International Portrait Prize, which runs portrait photography competitions to help raise funds for AOWA.
Watch our Gout Q&A with Rheumatologist Dr Helen Keen by clicking here
Arthritis and Osteoporosis WA (AOWA) provides self-management programs for consumers living with arthritis. The programs consist of six classes held over six weeks. Facilitators lead the classes and help participants to identify high-value care options and empower them with “how-to” skills, based on scientifically evidenced ways to manage their Osteoarthritis (OA), Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS). These programs encourage interaction with others facing similar health-related challenges and enable health goal setting in a friendly, small group environment.
Keeping current with arthritis evidence
AOWA’s programs were originally created over fifteen years ago and have successfully helped people better manage their arthritis. However, as new evidence has emerged over the years, it was time to update the programs. AOWA knew that this would be a significant program of work to take on, so they employed a health professional with project management skills in June 2019 to lead the work.
Guided by a Steering Committee and supported by existing AOWA staff and a volunteer working group, the project commenced with the key objective of overhauling the programs. Through the team’s tireless efforts, the program materials were reviewed, updated, and polished. This was an extensive exercise as over 350’s relevant scientific paper references were embedded.
In addition, the OA knee program was reconfigured and expanded to include OA of any joint. This expansion has improved access to AOWA services for people living with OA – regardless of which joint/s is affected. The programs were renamed to ‘Arthritis KEYS program’, an acronym derived from the program’s objective: Knowledge Enhances Your Skills. The affordable KEYS programs are delivered as small group classes, either online or in-person at various locations.
Investing in service quality
Facilitators who lead the program are all currently registered health professionals or have a background as a trained health professional. To support the facilitators in their role and ensure a high-quality learning experience for consumers, AOWA embarked on a second project in July 2020. This project will design a training program that all facilitators will undertake before independently leading the KEYS programs. For this project, the training pathway will be redesigned to ensure that quality standards are achieved and upheld, and that training is efficient and utilises modern online learning modalities.
It has been a pleasure working in the Project Manager role. Despite several challenges along the way, including the emergence of the COVID-19 pandemic mid-project, the AOWA team and their support networks have a great “can-do” attitude and spirit.
In recognising the enormous value that AOWA volunteers bring to the organisation, a volunteer stream has opened for people to assist facilitators in delivering the KEYS programs with activities such as: distributing AOWA resources, sharing lived experience of arthritis, helping with group dynamics, and interacting with participants with empathy and understanding.
The University of Western Australia – Rheumatology Group
Since the start of the UWA supported inaugural Chair of Rheumatology the following lines of Rheumatology research have been established at UWA. These are progressing well and some details and highlights are listed below:
- WA Rheumatic Disease Epidemiologic Register (WARDER):
WARDER is a big-data project of population-based routinely-collected administrative health data over 35 years for patients with rheumatic diseases with individual health data tracked over time in four WA Health registries namely Hospital Morbidity Data System for all admissions, WA Cancer Registry for cancer development , WA Mortality Registry and the Emergency Department Data Collection for all ED visits. These de-identified data are then linked through the Western Australian Data Linkage System with data of half a million individuals (half with rheumatic disease patients and half are age and gender matched controls) stored on the secure UWA research server.
- a) Collaboration established with researcher Dr J Tieu and medical scientist S Lester at the Basil Hetzel Institute/ Adelaide University regarding outcomes (mortality /cancer risk) in patients with ANCA associated vasculitis
– two presentations to be presented at EULAR 2020 (which now will be an e-
Congress) with respective manuscripts in preparation
- b) Ankylosing spondylitis project (M Ognjenovic/E Kelty)
– one paper on risk factors for vertebral fracture in AS patients published (see below)
– one paper on mortality and causes of death completed and submitted
– one manuscript on cancer survival in preparation
- c) IgA vasculitis project (J Nossent):
– 2 more papers published (see below)
– 2 additional papers submitted for review (two to be presented at EULAR 2020)
– one manuscript on impact of comorbid conditions in IgAV in preparation
– awarded best clinical research poster prize at APLAR 2019 meeting
- d) Rheumatoid Arthritis project (K Almutairi)
– RA prevalence metanalysis paper submitted (accepted for EULAR 2020)
– data collection for WARDER ICD coding validity for RA completed- paper in
– RA hospital admission rate and reasons paper in planning phase
- e) Gout project (H Keen/D Lopez/W Raymond):
– data extraction and cleaning complete; projects planned are:
– risk for myocardial infarction flowing gout flare
– mortality risk for gout patients in WA
- f) Giant cell arteritis (GCA) project (H Keen):
– data extraction and cleaning complete; projects/analyses planned:
– GCA prevalence in WA /GCA and mortality risk/GCA and blindness
- g) Systemic Lupus Erythematosus project (W Raymond):
– mortality risk and causes of death for SLE patients in WA submitted
– cardiovascular events risk and outcome in SLE – ongoing analysis
– viral infections as a cause and consequence of SLE (collaboration with University
(Hospital) Tromso in Norway
- h) Juvenile arthritis project (TBA):
– in planning phase with applications for funding pending
2) Perth Lupus Nephritis study:
– paper published on prognostic relevance of histological findings of Tubuloreticular bodies (see below)
– paper presented at ACR 2019 on usefulness of repeat biopsies – manuscript in preparation
3) Perth Lupus Registry:
– 181 patients in SCGH catchment have consented
– continuous data entry
– new research assistant recruited ( Michael Furfaro)
– redevelopment of online database (Redcap) near completion
– HREC approval extended to 2025/approval for expansion to FSH/RPH sites ongoing
– 2 papers from PLR data (on clinical SLE features and on direct health care cost for
SLE in WA) to be presented at EULAR 2020
4) Collaboration with assoc. profs G. Eilertsen and G. Bakland at the University (Hospital) Tromsø in Norway on the Tromsø SLE study and axial SpA cohort studies has been concluded with 4 papers published (see list).
List of published scientific papers (all papers acknowledge the support provided by AOFWA):
- Sharma C, Raymond W, Eilertsen G, Nossent J. Association of Achieving Lupus Low Disease Activity State Fifty Percent of the Time With Both Reduced Damage Accrual and Mortality in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken). 2020;72(3):447-51.
- Ognjenovic M, Raymond W, Inderjeeth C, Keen H, Preen D, Nossent J. The risk and consequences of vertebral fracture in patients with Ankylosing Spondylitis: a population-based data linkage study. J Rheumatol. 2020.
- Nossent JC, Raymond W, Keen H, Preen DB, Inderjeeth CA. Infection Rates Before and After Diagnosis of IgA Vasculitis in Childhood: A Population-wide Study Using Non-exposed Matched Controls. J Rheumatol. 2020;47(3):424-30.
- Al Mutairi KB, Nossent JC, Inderjeeth CA. Validity of Self-reported Diagnosis of Rheumatoid Arthritis. J Rheumatol. 2020.
- Raymond WD, Eilertsen GO, Shanmugakumar S, Nossent JC. The Impact of Cytokines on the Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Journal of clinical medicine. 2019;8(6).
- Raymond WD, Eilertsen GO, Nossent J. Principal component analysis reveals disconnect between regulatory cytokines and disease activity in Systemic Lupus Erythematosus. Cytokine. 2019;114:67-73.
- Nossent JC, Sagen-Johnsen S, Bakland G. Disease Activity and Patient-Reported Health Measures in Relation to Cytokine Levels in Ankylosing Spondylitis. Rheumatology and therapy. 2019;6(3):369-78.
- Nossent JC, Sagen-Johnsen S, Bakland G. IL-1A gene variation in relation to cytokine levels and clinical characteristics in ankylosing spondylitis. European journal of rheumatology. 2019;6(2):67-70.
- Nossent J, Raymond W, Ognjenovic M, Kang A, Chakera A, Wong D. The importance of tubuloreticular inclusions in lupus nephritis. Pathology. 2019;51(7):727-32.
- Nossent J, Raymond W, Keen H, Inderjeeth C, Preen D. Pregnancy outcomes in women with a history of immunoglobulin A vasculitis. Rheumatology (Oxford). 2019;58(5):884-8.
Other Rheumatology researchers/activities in WA
- Associate Professor Helen Keen (at FSH/RPH) is currently investigating
- The continued role for ultrasound examination in the diagnosis an management of various joint diseases including gout and osteoarthrosis
- The efficacy of an early referral clinic for patients with Giant cell arteritis where rapid ultrasound examination of the temporal arteries is used to guide management. If successful this will obviate the need for tissue biopsies and help reduce the occurrence of vision loss as the most devastating complication of this condition.
- A clinical trial of the use of Krill oil to reduce flare frequency in gout patients
- Establishing a local branch of the Australian Arthritis and Autoimmune Biobank Collaborative (https://nsw.biobanking.org/biobanks/view/70), where bio samples (serum, DNA and tissue samples) collected from consenting patients with a range of rheumatic diseases can be stored for later access by researchers for specific projects (genetic, molecular, translational).
1: Cai G, Keen HI, Host LV, Aitken D, Laslett LL, Winzenberg T, Wluka AE, Black
D, Jones G. Once-yearly zoledronic acid and change in abdominal aortic
calcification over 3 years in postmenopausal women with osteoporosis: results
from the HORIZON Pivotal Fracture Trial. Osteoporos Int. 2020 May 2
2: Loh K, Sharma C, Keen HI. Australian tertiary institutions are failing people
with gout. Intern Med J. 2020 Mar;50(3):386.
3: Chowalloor P, Raymond WD, Cheah P, Keen H. The burden of subclinical
intra-articular inflammation in gout. Int J Rheum Dis. 2020 Feb 27.
4: Keen HI, Robinson PC, Dalbeth N, Hill C. Time to recognise gout as a chronic
disease. Med J Aust. 2020 Apr;212(6):285-285.
5: Laslett LL, Antony B, Wluka AE, Hill C, March L, Keen HI, Otahal P, Cicuttini
FM, Jones G. KARAOKE: Krill oil versus placebo in the treatment of knee
osteoarthritis: protocol for a randomised controlled trial. Trials. 2020 Jan
6: Wong PC, Lee G, Sedie AD, Hanova P, Inanc N, Jousse-Joulin S, Ohrndorf S,
Stoenoiu MS, Keen HI, Terslev L, D’Agostino MA, Bruyn GA. Musculoskeletal
Ultrasound in Systemic Lupus Erythematosus: Systematic Literature Review by the
Lupus Task Force of the OMERACT Ultrasound Working Group. J Rheumatol. 2019
7: Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, Bruyn GAW,
Collado P, Damjanov N, Dejaco C, Delle-Sedie A, De Miguel E, Duftner C, Gessl I,
Gutierrez M, Hammer HB, Hernandez-Diaz C, Iagnocco A, Ikeda K, Kane D, Keen H,
Kelly S, Kővári E, Möller I, Møller-Dohn U, Naredo E, Nieto JC, Pineda C, Platzer
A, Rodriguez A, Schmidt WA, Supp G, Szkudlarek M, Terslev L, Thiele R, Wakefield
RJ, Windschall D, D’Agostino MA, Balint PV; OMERACT Ultrasound Cartilage Task
Force Group. Development of semiquantitative ultrasound scoring system to assess
cartilage in rheumatoid arthritis. Rheumatology (Oxford). 2019 Oct
8: Terslev L, Naredo E, Keen HI, Bruyn GAW, Iagnocco A, Wakefield RJ, Conaghan
PG, Maxwell LJ, Beaton DE, Boers M, D’Agostino MA. The OMERACT Stepwise Approach to Select and Develop Imaging Outcome Measurement Instruments: The
Musculoskeletal Ultrasound Example. J Rheumatol. 2019 Oct;46(10):1394-1400.
9: Sharma C, Keen H. Ten-year retrospective review of the incidence of serious
infections in patients on biologic disease modifying agents for rheumatoid
arthritis in three tertiary hospitals in Western Australia. Intern Med J. 2019
10: Ihdayhid D, Edelman J, Keen HI. Vaccination for hepatitis B virus in an
Australian pre-biologic population with rheumatoid arthritis. Clin Exp Rheumatol.
Clinical Professor Charles Inderjeeth (at SCGH)
- Is involved in clinical trials of new drugs for various rheumatic conditions through Linear Clinical Research (https://www.linear.org.au/about-us/) which is a state-of-the-art, clinical trials facility operating out of QEII Medical Centre to make innovative therapies available to the local community.
- Has main research interest in the clinical field of bone health and is involved in clinical and more basic studies into various aspects of both osteoarthrosis and osteoporosis
- Is involved in investigations into the effects of aging on cognitive and musculoskeletal health
1: Iddagoda MT, Inderjeeth CA, Chan K, Raymond WD. Prognostication accuracy of
final destination in poststroke patients requiring transitional care. Australas J
Ageing. 2019 Nov 19.
2: Inderjeeth CA, Raymond WD. Case finding with GARVAN fracture risk calculator
in primary prevention of fragility fractures in older people. Arch Gerontol
Geriatr. 2020 Jan – Feb;86:103940.
3: Iddagoda MT, Inderjeeth CA, Chan K, Raymond WD. Post-stroke sleep disturbances
and rehabilitation outcomes: a prospective cohort study. Intern Med J. 2020
4: David SM, Chan K, Inderjeeth C, Raymond WD. Rehabilitation Indices associated
with sustaining a minimal trauma fracture within 12 months of a stroke in Western
Australia. Australas J Ageing. 2019 Jun;38(2):107-115
5: Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, Zhu K, Woodman RJ,
Hodgson JM, Lewis JR. Sarcopenia Definitions and Their Associations With
Mortality in Older Australian Women. J Am Med Dir Assoc. 2019 Jan;20(1):76-82.e2.
6: Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, Zhu K, Woodman RJ,
Hodgson JM, Lewis JR. Utility of four sarcopenia criteria for the prediction of
falls-related hospitalization in older Australian women. Osteoporos Int. 2019
7: Inderjeeth CA, Inderjeeth AJ, Raymond WD. A multicentre observational study
comparing patient reported outcomes to assess reliability of swollen and tender
joint assessments and response to certolizumab treatment as compared to clinician
assessments in rheumatoid arthritis. Int J Rheum Dis. 2019 Jan;22(1):73-80.
8: Inderjeeth CA, Raymond WD, Briggs AM, Geelhoed E, Oldham D, Mountain D.
Implementation of the Western Australian Osteoporosis Model of Care: a fracture
liaison service utilising emergency department information systems to identify
patients with fragility fracture to improve current practice and reduce
re-fracture rates: a 12-month analysis. Osteoporos Int. 2018 Aug;29(8):1759-1770.
9: Bernard S, Inderjeeth C, Raymond W. Higher Charlson Comorbidity Index scores
do not influence Functional Independence Measure score gains in older rehabilitation patients. Australas J Ageing. 2016 Dec;35(4):236-241.
Dr Graeme Carroll (at FSH) is focussed on researching
- the role of the protein mannose binding lectin (MBL) in Rheumatoid Arthritis, especially the effect that MBL deficiency has in the disease course and complications (infections/lung disease) for patients with rheumatoid arthritis.
- causal factors and treatments for the arthritis that complicates Haemochromatosis and the implications for management of this arthropathy and possibly one common form of Osteoarthritis;
- patterns of joint disease (phenotypes) in Osteoarthritis and the potential mechanisms whereby joint laxity or hypermobility due to defects in collagen and other connective tissue macromolecules may contribute to some of these phenotypes.
1: Makin K, Easter T, Kemp M, Kendall P, Bulsara M, Coleman S, Carroll GJ.
Undetectable mannose binding lectin is associated with HRCT proven bronchiectasis
in rheumatoid arthritis (RA). PLoS One. 2019 Apr 10;14(4):e0215051.
2: Carroll GJ, Makin K, Garnsey M, Bulsara M, Carroll BV, Curtin SM, Allan EM,
McLean-Tooke A, Bundell C, Kemp ML, Deshpande P, Ihdayhid D, Coleman S, Easter T, Triplett J, Disteldorf T, Marsden CH, Lucas M. Undetectable Mannose Binding Lectin and Corticosteroids Increase Serious Infection Risk in Rheumatoid
Arthritis. J Allergy Clin Immunol Pract. 2017 Nov – Dec;5(6):1609-1616.
Assoc Prof R Will (at Colin Bayliss Research and Teaching Unit, Victoria park)
- Is researching the efficacy of various (mechanisms of ) drug delivery on pain modulation for patients with osteoarthrosis
- Participates in drug trials for a number of rheumatic conditions
1: Wright A, Benson HAE, Moss P, Will R. Monitoring the Clinical Response to an
Innovative Transdermal Delivery System for Ibuprofen. Pharmaceutics. 2019 Dec
9;11(12). pii: E664.
2: Moss P, Benson HAE, Will R, Wright A. Patients With Knee Osteoarthritis Who
Score Highly on the PainDETECT Questionnaire Present With Multimodality
Hyperalgesia, Increased Pain, and Impaired Physical Function. Clin J Pain. 2018
3: Wright A, Benson HAE, Will R, Moss P. Cold Pain Threshold Identifies a
Subgroup of Individuals With Knee Osteoarthritis That Present With Multimodality
Hyperalgesia and Elevated Pain Levels. Clin J Pain. 2017 Sep;33(9):793-803
Reduced organ damage and premature mortality for patients who achieve prolonged periods with low disease activity validates treat- to- target approach in lupus
By Professor Hans Nossent
Systemic Lupus Erythematosus (SLE) is a systemic autoimmune condition of unclear causes of the disease and with wide-ranging manifestations. Despite developments in the field, SLE patients still face a threefold increase in mortality and score lower on health-related quality of life assessments.
A major cause of morbidity is the cumulative organ damage due to persistent inflammation. Higher levels of organ damage are seen with persistently high disease activity and have a profound impact on a patient’s quality of life, causing significant levels of disability and unemployment. This has led to a push to develop a treatment strategy that results in minimising disease activity with a consequent reduction in organ damage.
Treat-to-target (T2T) has been defined as “a strategy aimed to treat patients to a goal which is capable of improving disease outcome”. This approach is currently already accepted in the follow-up of patients with Rheumatoid and Spondyloarthritis.
Still, it has been harder to define for SLE as the ultimate target of disease remission is achieved in less than 10% of patients, regardless of the definition used. According to the international task force, DORIS (Definitions of Remission In SLE) recommended that “the treatment target in SLE should be, the lowest possible disease activity, measured by a validated lupus activity index and/or by specific organ markers”.
For the first time, a reduction in mortality has been demonstrated for patients with SLE who were able to maintain a low disease activity state (LLDAS- see definition below) for more than 50% of their time spent with the disease.
Dr Chanakya Sharma and colleagues from Sir Charles Gairdner Hospital and the University of Western Australia analysed outcomes for 206 patients with SLE who were followed up for more than ten years (median 125 months).
They showed that lupus patients who spend most of the time (more than 50%) in Lupus Low Disease Activity State (LLDAS-50) have reduced organ damage accrual and also a significantly reduced mortality rate compared to patients who do not achieve LLDAS-50.
Approximately one-third of patients (69, 33.5%) spent at least half of the follow-up time in LLDAS-50. For these patients, there was a significant 63% reduced risk of severe damage and a 69% reduced risk of in age and sex-adjusted mortality compared to those patients who did not achieve LLDAS-50.
Some benefits were also seen for patients who achieved LLDAS for only 30% of follow-up, with a significant reduction in mortality and a strong trend towards a decrease in risk of severe damage.
Achieving long term low disease activity even with the use of medication, will thus significantly reduce the risk for organ damage and premature death among SLE patients.
Dr Sharma and colleagues wrote in the US scientific journal Arthritis Care and Research1 that the powerful effect seen on lupus outcomes now validates a treat-to-target (T2T) approach using LLDAS by clinicians overseeing the management of lupus patients.
A Lupus patient is said to be in LLDAS when they meet the following:
- SLE Disease Activity Index (SLEDAI) -2K less than 4, with no activity in major organ systems and no haemolytic anaemia or gastrointestinal activity;
- No new features of lupus compared with the previous assessment;
- Physician global assessment (PGA, scale 0–3) less than1
- Current prednisolone (or equivalent) dose less than 7.5 mg daily
- Well tolerated standard maintenance doses of immunosuppressive drugs
- 1. Arthritis Care Res, 2020 Mar;72(3):447-451. doi: 10.1002/acr.23867
Sharma C, Raymond W, Eilertsen G, Nossent J. Association of Achieving Lupus Low Disease Activity State Fifty Percent of the Time With Both Reduced Damage Accrual and Mortality in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken). 2020;72(3):447-451. doi:10.1002/acr.23867